Screening

Dr. Maha Moemen

 Learning objectives:
1- To identify the concept and objectives of
screening.
2-To identify characteristics of disease
suitable for screening.
3- to be able to calculate screening test
characteristics as sensitivity and
specificity.

 Definition:
It is the application of a test or procedure
to asymptomatic ,apparently well
individuals to separate those with high
probability of having or developing a
disease from those with a low probability
of having or developing the disease.
Those identified as likely to have the
condition will undergo further diagnostic
procedure.

 Periodic examination & screening:

Capable of wide application.

Apply relatively inexpensive tools.
Require little physician time.
Applied to those who don`t attend health
care facility.

Screening and case finding:

Case finding is the use of clinical
,laboratory or non-lab test to detect
disease in individuals seeking medical
care for other reasons.
e.g. detection of TB in patient suffering
from hypertention.

Screening and diagnosis:

The purpose of screening is to segregate
those who may have the condition .it is an
initial step , it needs confirmation.
Diagnosis is a procedure to confirm or
disprove the existence of a disease or
abnormality.

Screening test
Done to those apparently
healthy

Diagnostic test
Done to those with suggestive
signs and symptoms

Applied to a group of individuals Applied to a single person

Results are based on one
criteria

Results are based on the

evaluation of a number of
symptoms, signs and
.investigation

Results are not conclusive

Results are conclusive and final

Less accurate

More accurate

Less expensive

More expensive

Not a base for treatment Basis for trearment

Concept and objectives of

screening
The goal of screening is to identify
affected individuals before onset of
symptoms so that action can be applied to
reduce risk of developing clinical disease
(i.e reduce morbidity) and severity or
death due to the disease (i.e.to improve
the outcome)

Uses of screening
:Case detection- 1
To identify unrecognized disease which does not
.arise from the patient request
:control of disease- 2
To prevent transmission of the disease to healthy
.community members
:Research purpose- 3
To estimate the prevalence of a disease and
subsequent screening will provide data on the
.incidence

Types of screening
:Mass screening- 1
Application of the screening program to the
whole population or population subgroup as
.adults, children ,industrial workers
;High risk or selective screening- 2
The screening program will be applied to a
selective group of population who are at a high
.risk e.g. cancer cervix in low social class

:Criteria for effective screening

Characteristics of a disease suitable for- 1
:screening
the disease should be a major public health -1
problem for the individual or community and
should have a serious consequences as human
.suffering or death
The disease should have a reasonably long -2
and /or detectable pre-symptomatic (pre-clinical)
.phase

 3- The disease should have a high

prevalent among screened population.
4-there should be a suitable screening test
available ,that can detect the disease or
the defect prior to the signs and
symptoms.
5-There is a good evidence that early
detection reduces morbidity and mortality.
6-Facilities should be available for the
confirmation of the diagnosis.

There should be an effective and - 7

acceptable treatment for the disease if
identified in an early stage, as it is
unreasonable to screen for disease with
.no available treatment
The expected benefit of early detection - 8
.out weight the risks and the cost

Characteristics of ideal screening

test
:A) Reliability
Does the test give the same result when repeated
?applications are made on the same individual
B) Acceptability
C) Safety
:D) Cost
.cost of applying the test itself-1
cost of performing additional tests on people with -2
.false positive to correct the test's mistakes

Validity
To what extent the test accurately measures
.which it suppose to measure
OR The ability of the test to separate or
distinguish those who have the disease
.from those who have not
e.g. glucosuria for diabetes, more valid or
.accurate is glucose tolerance curve

Validity :sensitivity&specificity
Does the screening test accurately indicate
the presence or absence of the disease or
?pre-disease state
True disease status is determined by the
most definitive diagnostic method, referred
.to as a gold standard
Sensitivity and specificity are used to
describe the performance of the screening
.test relative to the true disease status

Format for comparison of results of a

diagnostic test against the true disease
status
Screening
test

Disease

No disease

Total

Positive

True
False
positive (A) positive (B)

A+B

Negative

False
negative (c)

True
Negative
(D)

C+D

Total

A+C

B+D

A+B+C+D

Sensitivity
It is the percentage of persons with the disease of
interest who have positive test results i.e. it is
the ability of the test to identify correctly those
.who truly have the disease
Sensitivity=True positive/true positive+false
negative x100
Sensitivity=a/a+c x100

Specificity
Specifity is the percentage of persons without
the disease of interest who have negative
.test results
i.e. the ability of the test to identify correctly
.those who truly does not have the disease
Specifity =true negative/true negative+false
positive
Specifity = D/D+Bx100

Prevalence=A+C/ A+B+C+D x100

Positive predictive value=it is the percentage of
persons with positive test results who actually
.have the disease of interest
PV=a / a+b x100
Negative predictive value: is the percentage of
persons with negative test results who actually
.do not have the disease of interest
Negative predictive value=D / D+C x 100